workshop report on karnataka multi sectoral nutrition ... final report_workshop.pdf · workshop...
TRANSCRIPT
Workshop Report
on
Karnataka Multi Sectoral Nutrition Pilot Projects
Implemented under Karnataka Comprehensive Nutrition Mission
(KCNM)
through
Karnataka State Rural Livelihood Promotion Society (KSRLPS)
02.02.2017
Department of Rural Development & Panchayat Raj,
Government of Karnataka
and
World Bank
1
WORKSHOP REPORT
1. Background
1.1 Malnutrition is a major public health emergency in India today, with about 50% of
the population suffering from it in some form or the other viz. protein-calorie deficit
and/or micro-nutrient malnutrition. It is the underlying cause of substantial number of
deaths of under - 5 children in the country. Even if it does not lead to death, malnutrition
including micronutrient deficiencies, ends up in stunted growth that often leads to
permanent damage including impairment of physical growth and mental development,
and adds to health care costs.
1.2 India’s nutritional indicators are a cause of concern and progress in their
improvement has been extremely slow. The nutrition scenario in Karnataka on
indicators like the IMR, under 5 mortality and morbidity rate, under-three age stunted
children, under-three underweight children, prevalence of anaemia, Maternal Mortality
Rate (MMR,) Chronic Energy Deficiency indicators of women and prevalence of
anaemia among women between the ages 15-49 is far from satisfactory.
1.3 Realizing the gravity of situation, Hon’ble Chief Minister of Karnataka in his Budget
speech on March 5, 2010 announced, “The number of children suffering from
malnutrition is very significant in our State. Special efforts are required to be made for
overcoming this problem. The Government proposes to start a Comprehensive Nutrition
Mission. A provision of Rs 5 Crore will be made for this for a pilot project.” Karnataka
is the first State in the country to have announced a Comprehensive Nutrition Mission.
2. Introduction to the Workshop:
2.1 In this backdrop, the Karnataka Comprehensive Nutrition Mission (KCNM), through
the Karnataka State Rural Livelihoods Promotion Society (KSRLPS) with support from
the World Bank and the Japan Social Development Fund (JSDF) is implementing the
Multi-Sectoral Nutrition Pilot Project in Devadurga Block, Raichur District and
2
Chincholi Block, Gulbarga District. The implementation of the Pilot Project started in
July 2015.
2.2 The Pilot Project is not a food programme alone. It is a comprehensive programme
that first attempts to bridge the information/awareness deficit regarding proper
nutritional and health practices within the family and community, and within their
purchasing power. Thereafter, it proceeds to bridge the nutritional dietary gap for the
targeted groups, namely, infants below 3 years, adolescent girls, and pregnant women
with the objective of preventing underweight, stunting and wasting; low Body Mass
index among adolescent girls; and ensuring improved weight gain among pregnant
women to prevent low birth weight infants.
2.3 The KCNM aims to eradicate the problem of malnutrition by introducing innovative
strategy shifts that include the following:
i. Adopting the inter-generational, life cycle approach by addressing the nutritional
needs of infants, children, adolescent girls and pregnant and nursing mothers.
ii. Bridging the calorie-protein micronutrient deficit among the inter-generational
target groups by providing appropriate energy dense fortified supplementation for
consumption.
iii. Accelerating, integrating and tightly monitoring multi-sectoral ongoing programmes
that have impact on malnutrition, such as Immunization and Vitamin A
Supplementation, Anaemia Control, Water and Sanitation, etc., and achieving
convergence between the ongoing programmes so that they operate simultaneously,
and filling programmatic gaps.
iv. Increasing programme coverage by demand creation by involvement of the
community, NGOs, SHGs and Village Panchayats.
v. Launching a sustained general public awareness campaign, through the multimedia
and interpersonal communication mode to reach the general public, especially at the
grass-roots, regarding proper nutritional practices within existing family budgets
and proper child and maternal care and create demand for government programmes.
vi. Make available low cost energy foods for the general population through Public
Private Partnerships.
2.4 Considering that it has been nearly two years since the implementation of the
project, a Workshop was organised on 2nd February 2017 to explain to all stakeholders
within and outside Government regarding the strategy and interventions of the
3
comprehensive and inter-sectoral approach to combat malnutrition, to obtain feedback
on the lessons learnt and the early, positive results; determine the capability of the
project for up-scaling; discuss the need for motivating the private sector to produce low
cost Energy Food for the open market and elicit expert opinion on the introduction of 30
hour module developed by KCNM on Food/Nutrition Security and Public Policy in the
Post Graduate programmes for public policy, nutritional sciences and social work.
3. Participants:
3.1 The workshop was attended by 76 participants and included senior government
officers, academicians, staff of NGOs, industry representatives and practioners.
Representatives of the media were also present. The list of participants is at Annexure 1.
4. Inaugural Session:
4.1 The Workshop was inaugurated by Shri Subhash Chandra Khuntia, IAS, Chief
Secretary, Government of Karnataka. Shri Ranganath, IAS (Retd.), former Chief
Secretary, Government of Karnataka, Vice Chairman, and Karnataka Higher Education
Council was the Chief Guest. Ms Sushama Godbole, IAS, MD, National Rural
Livelihood Mission (NRLM) welcomed the guests and gave a background of the
workshop.
4.2 Dr Nagambika Devi, IAS, Principal Secretary, Department of Rural Development
and Panchayat Raj, Government of Karnataka, in her opening remarks, pointed out that
while Karnataka is showing good economic growth, the same cannot be said about the
nutritional aspect. Poor nutritional status adversely affects the cognitive functioning and
learning levels of children. Inadequate/improper nutrition particularly of children below
3 years of age leaves irreversible damage. She lauded the efforts of KCNM in selecting
the most backward districts for the pilot implementation of the project, and said that if
the projects can be successful in these two blocks, they can be successful anywhere. It
would also pave the way for replicability and engagement of partners, particularly
4
women, to manufacture nutritional supplements such as EDFs at affordable costs. This
would also lead to women’s empowerment. She felt strongly about the need for
including nutrition as a part of academic curriculum for students.
4.3 Ms Mohini Kak, Senior Public Health Specialist, World Bank, highlighted the
salient features of the project and its true comprehensive scope, based on the life cycle
approach; focus on convergence of services having an impact on nutritional status, for
instance sanitation; and strong leadership and ownership by both Government and
Karnataka Comprehensive Nutrition Mission. While the early trends from the
implementation perspective have been positive, there is a need for further discussion on
the modality for nationwide scalability – whether to take the project as a model by itself,
or adapt elements of the project or any other learning.
4.4 Ms Veena Rao, IAS (Retd), Advisor, Karnataka Comprehensive Nutrition Mission,
presented the background of the project and its genesis. She informed that the project
was being implemented through the Rural Development Department because of its inter-
sectoral nature. Rural Development by its very nature is inter- sectoral , converging all
developmental activity in the Zilla Panchayats and Taluka Panchayats, particularly in
relation to women and child development , health, water and sanitation, which have a
direct bearing on the nutritional status. She explained the special inter - generation
strategy being used in this project, simultaneously addressing the nutritional and health
requirements of infants, adolescent girls and pregnant and lactating mothers and the real
time monitoring of each beneficiary. Citing the NNMB statistics from Technical Report
No 26 on nutritional status, she pointed out the vast micro and macro nutritional deficits
among the population, in all age groups and both the genders. Realizing the gravity of
situation in the state, Karnataka was the first state in the country to have announced a
Comprehensive Nutrition Mission. She thanked Shri Ranganath, the then Chief
Secretary for making it happen in the year 2012. She referred to the vacuum in the
Indian market for low cost energy foods, and said that it is presently filled up by junk
foods and tobacco based products. This market vacuum is to a large extent responsible
for persisting under-nutrition and micronutrient deficiency among children, women and
5
adolescents among the poorest sections of the population. There is an urgent need to
make energy dense foods available to this segment of the population if the problem of
malnutrition is to be overcome. Presently there are no low cost, high energy foods
available in the market for purchase and if cash transfers in lieu of supplementary food
programmes are made in future, there would no product available in the market for
purchase. There is a need to look at various strategies like partnering with the private
sector to set up viable units for production of low cost high Energy Dense Food (EDF)
for the open market. Another important aspect that she brought to the notice of the
gathering was the need for including food and nutrition as a part of the public policy
curriculum. She referred to the 30 hour module prepared by KCNM which needs to be
discussed and implemented.
4.5 Shri Alok Kumar, IAS, Advisor, NITI Aayog, Government of India, New Delhi,
hoped that the project would generate sufficient evidence and learnings for scaling it
countrywide. Analysing the issue of malnutrition in the country, he said that it is strange
that with its current level of economic development, it has not been able to succeed
satisfactorily in its efforts towards tackling the problem of malnutrition. This being the
situation, he referred to a few shortfalls which need to be looked at critically:
i. Lack of geographical convergence of large programmes which have complementary
inputs to tackle the problem of malnutrition for eg, major programmes which
address the issue of malnutrition like ICDS (High Burden Districts with focus on
nutritional status), NRHM (High Priority Districts with focus on health indicators,
and ISNIP (World Bank supported project with focus on ICDS restructuring) when
mapped on geographical coverage, are commonly implemented only in 11 Districts.
ii. Lack of programmatic convergence spreading the resources thin – Same beneficiary
groups are targeted by different departments, for eg. adolescent girls in SABLA
(ICDS) and Rashtriya Kishor Swasthya Karyakram (NHM).
iii. Results of a project/ programme are not commensurate with budgets, thereby
establishing the need for effective delivery at field level.
iv. Inaccurate data which affects monitoring and measurement of project progress and
for holding personnel accountable. In this regard he spoke of the digitisation efforts
towards obtaining data on a daily basis, which would eliminate the need for large
scale surveys.
6
v. Nutritionally rich foods at the village level are not accessible for children. Effort at
working closely with industries and motivating them to meet this segment of the
market is required.
4.6 Shri Ranganath, IAS (Retd.), former Chief Secretary, Government of Karnataka,
Vice Chairman, Karnataka Higher Education Council, hailed the project for its
uniqueness in terms of addressing the twin issues of intergenerational inequities and its
resolution. He referred to Prof. Ramalingaswamy who talks of malnutrition as a south-
asian enigma (in the paper Ramalingaswami, V. U. Jonsson and J. Rohde. 1996. The
Asian Enigma: Progress of Nations. New York: UNICEF) and expressed serious
concern that the nutritional status of children in our county is graver than the Sub-
Saharan countries. The nutritional data as indicated by the baseline in the selected
projects is appalling and calls for action. While nutritional supplements to address the
problem are fine and laudable, there is a need to look at long term sustainable solutions
using local and natural foods. Training the community in these efforts is very important.
He also emphasized that any nutritional programme for children will be successful only
when the status of women is improved. He corroborated this with the example of
Bangladesh where women are empowered as substantiated by the presence of large
number of women in workforce; many elected representatives and with more girl
children in schools. Even in India, there have been positive impacts when women were
engaged in the white revolution. Further, he quoted from studies by James Heckman on
the importance of early childhood care as an investment for greater dividends and
stressed on the need for appropriate and adequate nutrition for proper cognitive growth
among children. He stated that the magnitude of malnutrition is sometimes not
recognized by policy makers who go by previous year’s budgetary allocations while
planning, which in itself may be abysmally low. Hence, impact remains low because of
incomplete interventions and low funding. He emphasised the role that media could play
in initiating a public discourse on the issue of malnutrition.
4.7 Shri Subhash Chandra Khuntia, IAS, Chief Secretary, Government of Karnataka,
gave the presidential address. He said that the problem today is not one of non-
7
availability of food, but of consumption of balanced food to meet the nutritional
requirements. If this is accorded priority, human development will take place and
economic development would soon follow. He substantiated this by citing the
experiences of Cuba where the ‘Basic Needs Approach’ is followed wherein nutrition,
health and educational facilities are given to all. The intergenerational approach of the
project assumes importance as it addresses the nutritional needs of pregnant women,
children and adolescent girls. The results of the project are encouraging. There is a need
to converge the services of ICDS catering to children below 6 years of age as also to
extend the ambit of the Right to Education Act to secondary level of schooling, so that a
large number of children benefit from nutritional interventions. Tracking every child at
anganwadi centres and schools, as in the pilot project, would be highly beneficial to plan
for effective services. There is a need to create greater awareness among all local
stakeholders -AWWs, health workers, panchayat members, NGOs, media and the like
about the issue and their role in addressing this great challenge at grassroots level. He
assured of extending all support in implementing the project and in up scaling it.
5. Proceedings of the Workshop:
The Workshop had four sessions with the following themes:
Session I Lessons from the Pilot Project – Taking them forward.
Session II Introduction of a 30 hour module on food/nutrition security and
public policy in the post-graduate programme for public policy.
Session III Introducing Low Cost Energy Dense Foods in the market:
Monitoring the private sector.
Session IV Next step and action points
The Workshop schedule is at Annexure 2.
5.1 Session I:
The session on Lessons from the Pilot Project – Taking them forward was chaired by
Shri Alok Kumar, IAS, Advisor, NITI Aayog, Govt. of India, New Delhi.
8
The speakers included:
Ms Uma Mahadevan, IAS Principal Secretary, Department of Women and Child
Development, Govt. of Karnataka
Ms Mohini Kak, Senior Public Health Specialist, World Bank
Shri Anirudh Sravan, IAS, Chief Executive Officer, Zilla Panchayat, Kalaburagi District
Shri Kurma Rao, IAS, Chief Executive Officer, Zilla Panchayat, Raichur District
5.1.1 Ms Uma Mahadevan shared some important concerns on the issue of malnutrition
which she said, warrant attention:
i. Availability of accurate data- For the effective implementation of any programme,
reliable and valid data is a must. The latest NFHS IV data is presently available only
for 17 states, inclusive of Karnataka. The data itself has come after 10 years and
data in full form is required for any analysis, drawing comparisons and planning the
road map.
ii. Linking of parameters: Efforts towards analysing linkages between various
parameters - supportive or disruptive, are essential from a programmatic
perspective. Illustrative is the link between number of young married women
between 20-24 years married before 18yrs and child marriage. Although figures
show a declining trend in the state, the fact that some are married below the
prescribed age indicates not only their rights violation, but also the fact that they
would be undernourished and anaemic at the time of marriage. Similarly, while the
data on stunting shows a decline, wasting has gone up. This happens in a context
like drought, shortage of nutritious food etc. There is also a link between wasting
and diarrheal diseases. While large number of AWCs are run in own buildings,
some do not have toilets. Efforts have been made by the Women and Child
Development Department to improve sanitary coverage.
iii. Supplementary Nutrition in ICDS: The nutrition services in ICDS are supposed to
be supplementary in nature and not a substitute. This needs to be kept in focus while
seeing its impact on nutritional status of children. She provided information about
the number of initiatives that have been taken by the government to improve
nutritional status of children like providing milk under Ksheera Bhagya Scheme,
eggs for SAM children, medical allowance of Rs 2000/- for purchase of medicines,
health check-up, etc. Eggs are also provided to children in High Burden Districts
and SC/ST groups to improve their nutritional status. Hot cooked meals have been
launched as a pilot project in four Talukas of the state. There is a move towards
height measurement to monitor stunting. Software is being piloted in 4 projects
which tracks children, achievement of development milestones, sends SMS alerts to
parents for immunization, etc. During the discussions, suggestions came up
regarding the need for assessing weight gain during pregnancy to identify at-risk
mothers; and synergy of efforts to avoid replications.
9
5.1.2 Ms Mohini Kak highlighted the key takeaways of the project:
i. Behaviour change communication- house to house visits, follow up meetings,
individual counselling, mass media strategies, multi-layered family communication
have been well structured and done effectively.
ii. Data usage – Capacity building of project personnel for keying in valid and reliable
data and its usage for course correction and decision making.
iii. Engagement of the community- the project has a larger reach, particularly women as
it is anchored by the Livelihood Mission, which works with self help groups.
Reaching out to many women and not just the targeted beneficiaries of the project
has made a difference.
iv. Access to food: Dietary diversity for basic consumption has been well advocated.
5.1.3 She concluded by saying that for up scaling, the pilot project can serve as a model
or the elements in the project that have worked, can be taken forward.
Shri Anirudh Sravan. P, IAS, Chief Executive Officer, Zilla Panchayat, Kalaburagi
District, presenting his observations on the lessons learnt, spoke briefly about the profile
of Chincholi Taluka where the pilot project is being implemented. It is one of the most
backward areas of the state. Agriculture is the main occupation and the presence of
industries is hardly seen. There is a huge concentration of Lambani community. Sharing
his experiences on project implementation, he acknowledged that features like its multi-
sectoral nature and its anchorage by the Rural Development Department have
contributed to its effective implementation. The idea of packaged nutritive food is also
good and is likely to raise the bar for Anganwadis. However, there are a few challenges
like:
i. Language is a major issue for communication. The dialect spoken by this
community is very different and not many of them understand Kannada, the official
language of the state. Even the learnings of children in school are affected because
of this issue.
ii. Administrative issues are overwhelming. Large number vacancies in the health,
revenue and allied departments affect governance. Human resources at the field
level lack the skills to understand the modern technology. Digital connectivity is
poor.
iii. Traditional practices in child rearing are widely accepted and practiced even if
unscientific.
iv. Advocacy interventions are well implemented, but those which need literacy skills
like wall writing fail as the literacy levels are low.
10
v. Honorarium given to village nutrition volunteers is poor and leads to high attrition.
5.1.4 Looking at the road ahead, he had a few suggestions to offer:
i. Strengthening of the existing machinery like AWWs, ASHA, mid-day meal cooks to
deliver effective results. Greater capacity building efforts to improve their capability
in enhancing the nutritional status of women and children.
ii. Need to look at improving livelihoods. While a milk chilling plant has been set up in
the taluka, its impact on the nutritive levels needs to be seen. Poultry and dairy
farms could also be looked at as livelihood interventions.
iii. Jowar and seasonal vegetables are largely consumed by the community. A study of
their eating pattern will help in suggesting those supplementary foods that need to
be a part of the diet which are affordable and acceptable.
iv. Concurrent monitoring to ensure the data is sanitized and not biased.
5.1.5 Shri Kurma Rao, IAS, Chief Executive Officer, Zilla Panchayat, Raichur District
also began his presentation by providing a brief profile of Devadurga taluka, which is a
backward district of the state. While reiterating that the Behaviour Change
Communication is a unique feature of the project, he had a few suggestions to make for
effective project implementation:
i. Grams are widely grown but hardly used in the community as they are not aware of
the benefits. Efforts at changing their food habits to use nutritional foods in their
daily diet are needed.
ii. Need for synergy between nutrition services and other services like sanitation.
iii. Burdening of grass root staff with food distribution activity side-lines the nutritional
focus. Effective mechanisms for food distribution and to reach the food to the
delivery point without pilferage and leakage are required.
iv. Wider usage of local foods in the nutritional programmes will ensure its easy
acceptance
v. Convergence of services at the grass root level by AWWs, ASHA, school teachers is
very important for improving health and nutritional status.
vi. Community engagement will surely ensure project success besides establishing its
sustainability. Intensive efforts towards this are required.
5.1.6 An open house discussion threw up some more suggestions:
i. Use of community radio for wider reach of messages. Dissemination should be in
local language for better understanding.
ii. Use the parameter of height measurement in AWCs and provide adequate training to
the personnel on this aspect
11
iii. The growth period between 6-12 months being the most critical in the child’s
development, a thorough review and analysis needs to be carried out on the data of
children in this age group, on identified parameters.
iv. All interventions need to be adequately funded. Sub optimal funding should not be
accepted as the results would be impacted.
v. Malnutrition and non-communicable diseases are closely linked. The message that
‘healthy babies, less chances of such diseases’, should be advocated.
vi. Supplementation of foods on a continual basis by the Government is not always
possible. Promoting best food practices in the community is a sustainable solution.
5.2 Session II
5.2.1 Shri S.V. Ranganath, IAS (Retd), former Chief Secretary, Govt. of Karnataka,
Vice Chairman, Karnataka Higher Education Council chaired the session on
Introduction of a 30 hour Module on Food/Nutrition Security and Public Policy in the
Post-graduate Programme for Public Policy(Background Paper on Module is at
Annexure III).
The Speakers for this session were:
Ms Shalini Rajneesh, IAS, Principal Secretary, Health and Family Welfare, Govt. of
Karnataka.
Shri Jawaid Akthar, IAS, Principal Secretary, Medical Education, Govt. of Karnataka.
Dr G.N.V. Brahmam, Scientist 'F' (Retd.), NIN, ICMR.
Dr Srilatha Rao Seshadri, Professor, Public Health, Azim Premji University.
Dr S.A. Kazi, Professor and Head, Department of Social Work, Karnataka State
Women’s University, Vijayapur.
Dr Shanta Maria, Dean Faculty of Home Science, Mount Carmel College, Bangalore.
5.2.2 Shri Ranganath chairing the session reiterated the important linkage between the
nutritional status of the population of a country and its development. He said, India is
saddled with the problems of micro nutritional deficiency and chronic nutritional
deficiency and sadly, these issues are not getting due attention. There is hardly any
public debate on the subject. He stated that Universities need to address the issue with an
interdisciplinary approach. Universities should provide thought leadership and mould
the students’ thinking and perspectives. Those who graduate can help the policy makers
to address the issue more meaningfully. He said that the draft module would be carefully
12
reviewed by an expert committee constituted by the Higher Education Council. The
Council after this exercise would advise the Universities regarding introduction of the
module in its curriculum.
5.2.3 Ms Shalini Rajneesh suggested that a mother-child tracking system be introduced
particularly flagging those with malnutrition. Fixing of responsibility, taking action and
reporting feedback should be made mandatory to effectively address the issue of
malnutrition. She also pointed out that Multi-Purpose Supplementary Food Production
Centres (MSPC under ICDS) were in operation in all the Districts, there were Self Help
Groups of women in all villages who have the capital and their services could be
immediately availed for manufacturing EDF. This would also provide them with income
generating activity.
5.2.4 Shri Jawaid Akthar observed that whenever nutritional issues are being addressed,
they are child centred as is the case in ICDS. While approaches to health issues are quite
focussed, since nutrition is sectoral with need for interventions from varied sectors like
water and sanitation, health, food and civil supplies, agriculture and health, the focus
towards it is difficult. Hence, multi-sectoral approach, as in the present pilot project, is
crucial in tackling the problem of malnutrition. He expressed that the module on
Food/Nutrition Security is as much essential to medical education as it is to public
policy. The medical graduates need to be oriented too, to the subject as they are the
primary heath caregivers. However in their case, there is also a need for greater
emphasis on micronutrient supplementation
5.2.5 Dr Brahmam appreciated the initiative taken by the KCNM in preparing a module
on Food/Nutrition Security. He said that the content is well structured with adequate
practical orientation. He expressed that all stakeholders need to be appraised on the
nutritional aspects. Talking about the project, he stressed on:
i. Need for assessment, analysis and action at every level to reach any cognizable
outcomes.
ii. Promoting indigenous efforts like the use of local events calendar for estimating the
month of birth for accurate assessment of nutritional status.
13
iii. Propagating usage of locally grown food grains/vegetables and fruits for ensuring
sustainability of the programme and utilizing appropriate behaviour change
communication towards this.
iv. Careful planning for scaling from pilot, controlled conditions to a larger scenario
wherein conditions may vary enormously.
5.2.6 Dr Srilatha Rao lauded the module for its comprehensiveness that covered:
i. Historical perspective of risk and vulnerability particularly from colonial to present
times.
ii. Emphasis on intersectionality –caste, class and gender to point out to different kinds
of vulnerabilities.
iii. Consolidation of global learnings and its appropriate application to Indian scenario.
5.2.7 She suggested that the module could have:
i. More focus on the issue of governance.
ii. Strategies to build family commitment, engagement and awareness.
iii. Empowering communities to hold programme managers accountable and creation of
teams within community who are in general accountable for programme delivery.
iv. Effective utilization of data for decision making in addressing the nutritional issues.
5.2.8 Prof. S A Kazi was appreciative of the course module and expressed that Karnataka
State Women’s University was definitely interested in implementing the course. Making
a power point presentation, he pointed out that Karnataka State Women’s University,
Vijayapur, was already running Post Graduate and Doctoral programmes on Food and
Nutrition as also other courses on the theme through technology park-Ananya. He was of
the view that this module which has a thrust on public policy could well be integrated
with them. It could be a part of select post graduate programmes like Women Studies and
Social Work in all Universities of the State too. There would be operational requirements
like faculty, appropriate curriculum to cater to students from the streams of Science and
Social Science, adequate budget etc.
5.2.9 Dr Shantha Maria making a power point presentation on the subject pointed out
that students studying Nutrition need to definitely study Public Policy and vice versa.
While they would mutually benefit academically from such inter - disciplinary approach,
they would also be able to contribute better to the policy making and its implementation.
14
Drawing parallels between the subjects, she said that the students of nutrition need to
understand the linkages between their subject and the policies that impact the quality of
life for eg. they need to understand the issues of food security, hidden hunger, income vs
food consumption, nutrition and food productivity, price subsidies and caloric
consumption from the perspective of policy in existence and its implementation.
Similarly the students of public policy need to have an insight into the policy in
implementation, alternatives considered for addressing an issue, reasons for rejecting
some alternatives, and the trade-offs in the selected policy. She drew attention to the need
for framing curriculum from an integrated and inter-disciplinary perspective, by way of
an example:
Public Policy Food and Nutrition
Ability to define a problem For Example : Malnutrition
Establishing Goals To overcome Low Birth weight
Selecting a policy To monitor pregnant women
Implementing a Policy Strategy adopted by government
(central /state) - implementing action
Evaluating a Policy Out come
5.10.10 She felt that public policy should be a part of higher education cutting across all
academic disciplines like agriculture science, education, health, technical education,
physical and biological sciences, social sciences and humanities. It would be of relevance
to various professionals too like administrators, academicians, business heads,
researchers etc. She expressed that the course module is well thought of and could be
introduced as mandatory or an inter disciplinary paper with credit points. She suggested
that such a course could encompass e-module, self study, contact workshops, field
exercise, examination and internship in the field through government. She stated that
such a module could also be introduced as an in-service course for departmental
promotions or career advancement in the relevant departments.
15
5.3 Session III
5.3.1 Dr N Nagambika Devi, IAS, Principal Secretary, Department of Rural Development
and Panchayat Raj chaired the session on Introducing Low Cost EDF in the market –
Motivating the Private Sector.
The following speakers shared their thoughts on the subject:
Dr Arijit Chakrabarty, GAIN
Shri Dinesh Hegde, Representative, FICCI; Pragathi Industries
Shri Vinay Kumar, Director, ISKON
Annexure IV presents the concept paper on “Low Cost EDF in the market – Motivating
the Private Sector.”
5.3.2 Dr Nagambika Devi opened the discussion about involving private sector in
manufacturing EDF, and pointed out that to achieve market penetration, few issues like
ensuring its affordability, palatability, quality and accessibility even in the most remote
areas, need utmost attention. She said that Karnataka has an enabling environment for
start-ups. There is a need to motivate women SHGs to use this opportunity to become
entrepreneurs. They will need guidance and mentoring to start the business. Using
Corporate Social Responsibility funds for this initiative can also be explored. Also vital is
to provide wide advocacy and publicity to the business opportunity available in this field
to attract ventures. Not many are aware of the business idea and volumes for EDF
production. She assured that Government would extend all support to provide linkages
required for this business.
5.3.3 Dr Arjit Chakrabarty analysing the market scenario for EDF emphasised that for an
Industry, there needs to be a business case. In case of EDF, he stated that there is an
adequate demand for this kind of food, people have aspirations, size of the market is
large, and an enabling environment is also present. What is required is for the market
players to enter into the arena to make EDF affordable and accessible. Citing the example
16
of iodised salt marketed by Tata Salt and I-shakti which are differentially priced and cater
to different sections of the buyer’s market largely owing to cost optimisation on transport,
he said that the larger players which are ‘for- profit commercial ventures’ could work out
strategies to enter into the lower end market as there is not only a business case, but the
social benefits are high. One could also explore motivating small enterprises to cater to
the local market. It makes sense to have inclusive business which serves the needs of the
poor through profitable commercial operations.
5.3.4 Shri Dinesh Hegde in is power point presentation, drew the attention of the group to
the magnitude of malnutrition in the country. He expressed that industries need to come
together and partner with the government to address the issue of malnutrition. EDF is a
viable business that could be set up as local Industry. Presently the larger pharma
companies are making neutraceutical products for elite community. It is high time that
these products are also made at affordable costs for the consumption of lower end market
and motivating Small Enterprises to engage in this business. The government needs to be
an enabler for these initiatives to become successful. He assured all support from FICCI
for this initiative.
5.3.5 Shri Vinay Kumar made a detailed power point presentation on the hot mid day
meal supplied by Akshay Patra, reaching 4.5Lakh of children in the state. The
Memorandum of Understanding has been signed with the Education Department of
Government of Karnataka. The goal of this activity is to improve the nutritional and
health status of schoolchildren in Karnataka by providing them access to essential
micronutrients and promoting health-enhancing behaviours. Presenting their business
model, he informed that foods are fortified - double fortified salt, fortified analogue soya
dal and fortified rice kernels. The meal is also prepared under strict hygienic conditions,
which minimizes exposure to germs via food contamination. It is affordable, tasty and
certainly nutritive. The volumes are large. Besides children, the services have been
extended to include others who may be malnourished like beggars in rehab centres,
patients in government hospitals, construction site workers, blue collar workers in private
industries particularly garment factories which have women intensive labour force and
17
municipality workers engaged in solid waste management. Akshay Patra has undertaken
feeding of anganwadi children in the age group of 3-5 years in Gujarat, Rajasthan, Uttar
Pradesh and Bangalore Municipality. He invited partners and thought leaders to use their
services. He stated that Akshay Patra would be happy to provide any kind of support for
distribution or outreach for this initiative.
5.3.6 In the open house discussion, some more concerns and suggestions emerged:
i. Larger players have a strong hold of the food market and the entry of small players
is strongly resisted.
ii. Demand for low cost energy foods should be created by having attractive flavors,
packaging etc to make it interesting to the kids. The marketing of foods should be
akin to Kurkure, noodles, chips etc which is available in every nook and corner of
the country.
iii. India is mostly rural in nature and diverse in its food preferences. Energy foods have
to cater to this need.
iv. The terminology ‘EDF’ needs to be revisited as it is normally associated with food
provided to SAM children.
5.4 Session IV:
5.4.1 Shri T.M. Vijay Bhaskar, IAS, Addl. Chief Secretary& Development
Commissioner, Government of Karnataka led the discussion on Next steps and Action
Points. Speakers who shared their thoughts on the theme included:
Ms Veena S Rao, IAS (Retd), Advisor, KCNM
Dr N Nagambika Devi, IAS, Principal Secretary, Department of Rural Development and
Panchayat Raj, Government of Karnataka
Dr Suresh K Mohammed, Senior Health Specialist, World Bank
Shri Ramachandra Rao, Team Leader, Karnataka Health Promotion Trust
5.4.2 Ms Veena Rao presented an overview of the discussions that had ensued during the
day. She highlighted the key concerns that emerged during discussions regarding project
implementation and the suggestions that emerged for improvement. She assured that data
cleaning wherever required will be taken up. The next steps towards scaling up will be
reviewed, whether to dovetail the components of the pilot project particularly the unique
18
features like Behavior Change Communication with existing programmes; or if the
project provides sustained results, then work out its up-scaling in the other backward and
severely malnourished blocks in the state and also recommend to Niti Ayog an evidence
based model to address the issue of malnutrition, for implementation where needed. She
also informed that the response towards the module particularly academia was
encouraging and the next step would be taken to approach the Higher Education Council
for further review by an expert committee. Discussion on the move towards motivating
the private sector to take up the manufacture of EDF was optimistic with the Government
having an enabling policy for start ups. She pointed out that sustainable production of
food can happen only with the market and by keeping government intervention minimal.
She also said that the suggestion on engaging women SHGs in this process was welcome
and efforts towards this will be initiated.
5.4.3 Dr Suresh Mohammed suggested that the market for EDF is quite large if the boys
are also brought into the ambit as many are malnourished in this group too. Also the
period of adolescence is quite an extended period and offers ample scope for
consumption. He was appreciative of the efforts of the CEOs and the personnel of the
pilot project who are all very motivated. He said that all implementation stake holders
have made it a centre of excellence for project implementation. However, there is scope
for more efficiency at the grass root level where more coordinated efforts would lead to
better outcomes. Going forward, there is a need to strengthen the volunteers by providing
cycles and weighing machines in view of their responsibilities. He also suggested that
there is a need for enhancing the honorarium being given to the Village Nutrition
Volunteers.
5.4.4 Shri Ramachandra Rao shared some of the challenges being faced by the project
staff:
i. Pilot project being implemented in the most backward Talukas, where the SC/ST
population is high and majority fall below poverty line.
ii. High attrition among staff particularly because of low honorarium. The project
envisaged a part time engagement but with added responsibilities it has become a
full time job for Village Nutrition Volunteers.
19
iii. Need for cleansing of data collected by volunteers.
iv. Inadequate information on Behavior Change Communication.
v. Large scale distress migration of families who move out after leasing their lands to
outsiders during drought.
vi. Sharing of EDF provided to girl children with their boy siblings.
5.4.5 He also gave some suggestions for consideration:
i. Need for more or special interventions beyond EDF for SAM children.
ii. Presently only 40% of the Taluka is covered by the project. There is a need to cover
the entire Taluka. Adequate EDF production for this purpose can be achieved by
revitalizing the existing defunct ICDS facilities.
iii. More training to be given to women engaged in running the factory and empowering
them on the lines of Kutumbashree run by Government of Kerala.
iv. Intensive training to the staff on Behavior Change Communication.
v. Enhancing the Honorarium of the Village Nutrition Volunteers.
5.4.6 Dr Nagambika Devi felt that the project has a bright future. However, she pointed
out that the concerns expressed by the Partner NGO and World Bank warrant attention.
Honorarium to the Village Nutrition Volunteers needs to be enhanced as it is meagre. The
idea of including boys as beneficiaries to overcome the issue of sharing food is a sound
one and merits review. Strategies to ensure this can be worked out. Regarding EDF, she
expressed that fresh ideas for packaging are needed to make it attractive. Sometimes wet
spoons are inserted into the storage bin making the entire food open to contamination.
Considering such storage issues, it can be packed as ‘use and throw’ sachets. SHG
federations can be encouraged to take up this venture. They can be extended all the
facilities as a start up. Hand holding will need to be given till they become sustainable. A
committee can be formed to standardize the food production operations which can then
be shared with women groups. They can be encouraged to come up with ideas for variety
in menu, packaging designs, marketing etc. Conversation with them about this is essential
to motivate them. Scalability of the project at the state and national level definitely needs
to be taken up after reviewing the learnings.
5.4.7 Shri Vijay Bhaskar expressed satisfaction at the outcome of deliberations of the
workshop. Several useful suggestions have come up for consideration by Government,
20
for more effective implementation of the project and for introducing a module on
nutrition and public policy. The GOK is quite concerned about the nutritional status of
women and children and have made constant endeavors to make the state hunger free.
Many initiatives like Ksheera Bhagya, Anna Bhagya etc have been introduced in this
backdrop. He said that the results of the pilot project are eagerly awaited by the
Government for looking into its scalability as it is a targeted intervention to tackle the
issue of malnutrition. He assured that the government will continue to support all
initiatives aimed at tackling the problem of malnutrition in the state as it has the dream of
making the state hunger free.
5.4.8 Responding to the many suggestions that emerged during the course of the
Workshop, he stated as follows:
i. If the model is successful, it can be replicated in other Blocks. However, the issue of
scalability needs to be reviewed from the perspective of cost per child in comparison
with ICDS. If high, cost reduction is to be attempted for scaling up the project.
ii. Effective coordination needs to be achieved to address the problem of malnutrition.
A multi-sectoral approach with the departments responsible for child, women and
maternal health care, nutrition, sanitation etc. working in tandem at the village level
is required to have a meaningful impact of the interventions.
iii. Sanitation is a crucial link to achieve nutritional gain. Taking into account the food
security interventions namely food availability, access and absorption; sanitation
plays an important role in ‘absorption’ and has a bearing on malnutrition. Hence
there is a need to focus on providing sanitation facilities in the two pilot projects and
making them open defecation free blocks.
iv. The Nutrition Module could be incorporated by Universities in their courses on
public policy, nutrition, public health, agriculture and social sciences.
v. If the Module is well received, it can be scaled up with the support of Niti Ayog,
Government of India.
vi. There is a need to develop a pool of nutrition experts who can handle the module
when it is introduced.
vii. Addressing the concern about low honorarium of Village Nutrition Volunteers.
viii. Karnataka has a ‘Grand Challenges Programme ’with the Department of
Information Technology and Bio Technology. This start-up programme can be also
be used to motivate the private sector for production of EDF to enable its
accessibility to the needy public at a reasonable cost. Government would incentivize
the private food companies to produce low cost energy foods for the open market
and make it accessible and affordable for children, adolescent girls and boys,
women, sick and the elderly from low income families.
21
5.4.9 Shri Vijay Bhaskar informed that he would call for a meeting with FICCI and food
manufacturers to see how nutritive food production can be taken up at local level. He
acknowledged that the project staff is working under challenging situations and they need
complete support of the government and other stakeholders in sustaining their efforts.
He concluded by stating that Devadurga and Chincholi being backward and challenging
blocks, success achieved here would be the highest justification for easy replication
elsewhere. He called upon all concerned to work together to make the project a success
and assured of all support from his end towards this.
5.3.10 The workshop concluded with a vote of thanks by Shri Basavaraju, KAS, Chief
Operating Officer, KSRLPS, who also anchored the programme.
22
Annexure 1
LIST OF PARTICIPANTS
Sl No. Name Designation
1. Mr Subhaschandra Khuntia, IAS Chief Secretary, GOK
2 Mr T.M. Vijay Bhaskar Addl. Chief Secretary & Development
Commissioner GOK
3 Mr S.V. Ranganath IAS (Retd) Former Chief Secretary GOK, and Vice Chairman,
Karnataka Higher Education Council
4 Dr N. Nagambika Devi, IAS Principal Secretary, RD & PR, M.S. Building,
Bangalore.
5 Ms Veena S Rao, IAS (Retd) Advisor, KCNM, Bangalore.
6 Ms Uma Mahadevan, IAS Principal Secretary, Women & Child
Development, M.S. Building, Bangalore.
7 Ms Shalini Rajaneesh, IAS Principal Secretary, Health & Family Welfare
Vikasa Soudha, Bangalore.
8 Mr Alok Kumar, Advisor, NITI Aayog, Govt. of India, New Delhi.
9 Mr Bharat Lal Meena, IAS Addl. Chief Secretary, Higher Education.
10 Mr Jawaid Akhtar, IAS Principal Secretary, Medical Education.
11 Ms Sushama Godbole, IAS Mission Director, KSRLPS.
12 Mr Kurma Rao CEO, Raichur District
13 Mr Anirudh Shravan CEO, Kalaburgi
14 Mr Basavaraj COO, KSRLPS.
15 Mr. Anil Rathod, EO, Chincholi.
16 Mr Meera Nayak EO, Devadurga
23
17 Ms Mohini Kak Health and Nutrition Specialist, World Bank
18 Mr Suresh Mohammed, Senior Health Specialist, World Bank
19 Mr ArjithChakrabarthy Senior Programme Officer, GAIN
20 Dr Bhrahmam Scientist ‘F’(Rtd), National Institute of Nutrition,
Hyderabad.
21 Dr Asna Urooj Nutrition faculty of Mysore University.
22 Dr H. Y Swadi HOD, Department of Social Work, Dharwad
23 Dr S. A Kazi Department of Social Work, State Women’s
University, Vijayapur
24 K Lenin Babu Department of Social Work, State Women’s
University, Vijayapur
25 Mr Kishore Attawar Roshni Nilaya, Mangalore
26 Dr Kodandarama HOD, Department of Social Work, Bangalore
27 Dr M. Bharathkumar Regional Director, NIPCCD, Bangalore
28 Mr Ramachandra Rao Team leader, Nutrition project, KHPT
29 Ms Agnita R.N Nutrition project, KHPT
30 Mr Manjunath Doddawad Nutrition project, KHPT
31 Mr Shivayogi B.M Nutrition project, KHPT
32 Ms Mala Makheeja M/s Akar Advertising and Marketing Pvt. Ltd.
33 Sri Vinay Kumar Director, ISKON, Bangalore
34 Dr Shreelata Rao Sheshadri Azim Premji Foundation
35 Dr Shantha Maria HOD, Mount Carmel College ( Home Science)
36 Ms Sumathi Swaminathan St. John’s College, Bangalore.
37 Ms Gayatri Singh UNICEF
24
38 Mr Khyati Tiwari UNICEF
39 Mr K. Vishwanath UNICEF
40 Dr M.S Tara Consultant, KCNM
41 Mr Vijayananda Dept. Of Information and Publicity
42 Mr D.A. Hegde Prakruthi Products
43 Mr. Devaraju S.K. Akshayapatra
44 Mr B Subramanyam Akshayapatra
45 Mr Prashantha Kumar Akshayapatra
46 Prof Y.S Siddegowda Prof, Dept of Social Work University of Mysore.
47 Mr. Y. Mahankalappa PRO, RD & PR
48 Dr Saraswathi Ayush Dept.
49 Dr Lalitha Ayush
50 Dr Arun Kumar Deputy Director, H&FWD
51 Dr A.R. Aruna Director, State Institute of H&FW
52 Dr Naveeda Khatoon Asst. Director, NIPCCD
53 Dr Rajani M Deputy Director, Child Health H&FWD
54 Dr Raj Kumar H&FWD
55 Dr B.S. Anuradha Consultant
56 Mr Surendra Kumar NGO
57 Mr Prakash Kumar KSRLPS
58 Ms Geetha N Bangari KSRLPS
59 Ms Mamatha S KSRLPS
60 Mr Sanjay P KSRLPS
25
61 Mr R. Habib Kumar KSRLPS
62 Mr Ashok Kumar KSRLPS
63 Mr M.M. Ali KSRLPS
64 Mr Sumanth KSRLPS
65 Ms Vindya KSRLPS
66 Mr M. Sudarshan KSRLPS
67 Mr Arul Kani KSRLPS
68 Ms Prathima KSRLPS
69 Mr. Ramesh R.M. Consultant (PMC), KCNM
70 Mr Ramesh Halbhavi Consultant (HR &Admn), KCNM
71 Mr. Ganesh Moolya Private Secretary to Advisor KCNM
72 Mr Satisha Procurement Assistant, KCNM
73 Mr. Nagaraja D.C Accounts Assistant, KCNM
74 Mr. Chethan S Computer Operator
75 Mr. Varadaraju Staff, KCNM
76 Mr Ramchandra K Staff, KCNM
26
Workshop Schedule
Dept. of Rural Development & Panchayat Raj, Government of Karnataka, and World Bank
Karnataka Multi Sectoral Nutrition Pilot Projects
implemented under Karnataka Comprehensive Nutrition Mission (KCNM)
through Karnataka State Rural Livelihood Promotion Society (KSRLPS)
Date: 02.02.2017
Venue: Hotel Capitol, Raj Bhavan Road, Bangalore
Inauguration and Plenary Session : 10.00 am to 11.50 am
9.30 to 10.00 am Registration
10.00 to 10.05am Inauguration Shri Subhash Chandra Khuntia, IAS, Chief
Secretary, Govt. of Karnataka
10.05 to 10.10 am Welcome address
Ms Sushama Godbole, IAS,
MD, NRLM
10.10 to 10.20 am Opening Remarks
Dr N Nagambika Devi, IAS,
Principal Secretary, Department of Rural
Development and Panchayat Raj, Govt. of
Karnataka
10.20 to 10.30 am Opening Remarks Ms Mohini Kak, Senior Public Health Specialist,
World Bank
10.30 to 10.40 am Project Strategy and
Progress
Ms Veena S Rao, IAS (Retd.)
Advisor, KCNM
11.40 to 10.50 am Special Address Shri Alok Kumar, IAS,
Advisor, NITI Aayog, Govt. of India, New Delhi
10.50 to 11.00 am Address by Chief Guest
Shri S V Ranganath, IAS (Retd.)
Vice Chairman, Karnataka Higher Education
Council, Karnataka
11.00 to 11.25 am Presidential Address Shri Subhash Chandra Khuntia, IAS
Chief Secretary, Govt. of Karnataka
11.25 to11.30 am Vote of Thanks Ms Sushama Godbole, IAS, MD – NRLM
11.30 to 11.50 am Tea Break
27
Session –I
11.50 am to
1.00 pm
Lessons from the Pilot Project – Taking them forward
Chair
Shri Alok Kumar, IAS, Advisor, NITI Aayog, Govt. of India, New Delhi
Speakers
Ms. Uma Mahadevan, IAS Principal Secretary, Department of Women and
Child Development, Govt. of Karnataka
Ms Mohini Kak, Senior Public Health Specialist, World Bank
Shri Anirudh Sravan, IAS, Chief Executive Officer, Zilla Panchayat,
Kalaburagi District
Shri Kurma Rao, IAS, Chief Executive Officer, Zilla Panchayat,
Raichur District
Discussion
Session – II
1.00 to 2.15 pm
Introduction of a 30 hour Module on Food/Nutrition Security and
Public Policy in the Post-graduate Programme for Public Policy
Chair
Shri S.V.Ranganath, IAS (Retd) former Chief Secretary, Govt. of
Karnataka, Vice Chairman, Karnataka Higher Education Council
Speakers
Ms Shalini Rajneesh, IAS, Principal Secretary, Health and Family Welfare,
Govt. of Karnataka
Shri Jawaid Akthar, IAS, Principal Secretary, Medical Education, Govt. of
Karnataka
Dr G.N.V. Brahmam, Scientist 'F' (Retd.), NIN, ICMR
Dr Shreelata Rao Seshadri , Professor, Public Health, Azim Premji
University
Dr S.A Kazi, Professor and HOD, Dept of Social Work, Karnataka State
Women’s University, Vijayapur.
Dr Shanta Maria, Dean Faculty of Home Science, Mount Carmel College,
Bangalore
Discussion
2.15 to 2.45 pm Lunch
28
Session III
2.45 to 4.00 pm
Introducing Low Cost EDF in the market – Motivating the Private
Sector
Chair Dr N Nagambika Devi, IAS, Principal Secretary, Department of Rural
Development and Panchayat Raj
Speakers
Dr Arijit Chakrabarty, GAIN
Shri Vinay Kumar, Director, ISKON
Shri Dinesh Chandra Hegde, Representative of FICCI
Discussion
4.00 to 4.30 pm Closing session: Next steps and action points
Chair
Shri T M Vijay Bhaskar, IAS, Addl. Chief Secretary& Development
Commissioner, Govt. of Karnataka
Speakers
Dr N Nagambika Devi, IAS, Principal Secretary, Department of Rural
Development and Panchayat Raj, Govt. of Karnataka
Dr Suresh K Mohammed, Senior Health Specialist, World Bank
Shri Ramachandra Rao, Team Leader, Karnataka Health Promotion Trust
Ms. Veena S Rao, IAS (Retd.),Advisor, KCNM
4.30 to 4.40pm Vote of Thanks Shri Basavaraju, KAS, Chief Operating Officer, KSRLPS
4.40 to 5.00 pm Tea
29
BACKGROUND PAPER
Karnataka Comprehensive Nutrition Mission
Karnataka Multi-Sectoral Nutrition Pilot Project
Project Background
The Karnataka Comprehensive Nutrition Mission (KCNM), through the Karnataka
State Rural Livelihoods Promotion Society (KSRLPS) with support from the World
Bank and the Japan Social Development Fund (JSDF) is implementing the Multi-
Sectoral Nutrition Pilot Project in Devadurga Block, Raichur District and Chincholi
Block, Gulbarga District.
Implementation of the Pilot Project started in July 2015.
The pilot project aims at improving nutrition outcomes by adopting an
inter-generational, life-cycle approach, through interventions focusing on the
nutritional and nutrition related needs of children from 0-3 years of age, adolescent
girls, pregnant and lactating women.
The Intergenerational Cycle of Malnutrition and Poverty is at Annexure -A
The Pilot Project is not a food programme alone. It is a comprehensive
programme that first attempts to bridge the information/awareness deficit
regarding proper nutritional and health practices within the family and
community, and within their purchasing power.
Thereafter, it proceeds to bridge the nutritional dietary gap for the targeted
groups, namely, infants below 3 years, adolescent girls, and pregnant women with the
objective of preventing child underweight, stunting and wasting; low body mass index
among adolescent girls; and ensuring improved weight gain among pregnant women to
prevent low birth weight infants.
The Strategy begins with a strong focus on the indirect determinants of
nutrition and conducting an intensive behaviour change communication
campaign to improve household behaviours regarding nutritional practices and
care related to infants, children, adolescents, and pregnant and lactating women,
within the household budgets.
30
It also focuses on increasing access by families and targeted groups to the
inter-sectoral services provided by prevailing Government programmes
that impact nutrition, particularly sanitation, immunization and safe drinking water.
At the next stage, the strategy focuses on the proximate determinants of
nutrition by providing fortified energy dense food (EDF) specifically
formulated for the three inter-generational target groups, to bridge the
protein-calorie-micronutrient gap in their diets. This EDF is produced by
women from local Self Help Groups who are working in Production Units that have
already been set up in both Chincholi and Devadurga.
Production and distribution of EDF started in Chincholi on October 22, 2016 and in
Devadurga on December 26, 2016. The EDF has been well received by the beneficiaries.
Global Alliance for Improved Nutrition, (GAIN) has provided support for setting up the
EDF Production Units in both Chincholi and Devadurga.
The project is being implemented in partnership with the NGO, Karnataka Health
Promotion Trust (KHPT).
Beneficiary details – Chincholi and Devadurga Blocks
Table-1
Taluka
Children
0-6
Months
Children
7-36
Months
Adolescent girls
11 to 18 years
Pregnant
women
Lactating
mothers Total
Chincholi 417 6038 8107 783 1660 17005
Devadurga 152 6522 8396 841 2090 18001
Total 569 12560 16503 1624 3750 35006
Project Interventions
A Village Nutrition Volunteer (VNV) is appointed in each village by the partner
NGO.
The VNV’s first task is to create Nutrition Cards for all beneficiaries through which
there is a monthly monitoring of height and weight, and several other parameters
specific to the target groups, such as, initiation of complementary feeding among
31
children, immunization status, Vitamin A and the Iron and Folic Acid Programme,
Sanitation and Safe Drinking Water.
SHGs are strengthened, and empowered through information and awareness on
nutrition and health so that they can be active participants in bringing about behavior
change.
VNVs motivate and assist the families to apply to the Panchayats for
construction of toilets in their homes. After Mission intervention in October
2016, 909 toilets have been constructed and are being used - (430 in Chincholi and 479
in Devadurga Blocks) as at the end of December 2016.
The core activity in the project is the regular house to house counseling
regarding essential health and nutritional messages. To prevent information
overload and to ensure that the messages start getting absorbed by the families in a
sustained manner, they are disseminated in phases, through household counseling,
through flipcharts and charts, through radio and Cable TV and through wall paintings.
Communication messages in the first phase focused on:
1. The inter-generational cycle of malnutrition
2. Improving dietary practices within family budgets and encouraging
consumption of traditional nutritionally rich local foods, such as, green leafy
vegetables, tomatoes, local grains and pulses, commonly grown fruits like
papayas, bananas etc.
3. Exclusive breastfeeding for infants during the first six months and
complementary feeding after 6 months
4. Proper care of the girl child throughout her life cycle, with particular reference to
intra-family food distribution and health care, and to improve the body mass
index among adolescent girls and women
5. Prevention of anaemia among girls and women.
The communication materials for the 2nd Phase have been finalized. They
focus on 6 subjects:
1. Educating pregnant women about the importance of proper birth weight of the
infant and ideal weight gain during pregnancy and prevention of low birth
weight
2. Advocating behavioural change in the family for additional nutrition to pregnant
and lactating women
32
3. Providing families information regarding proper age of marriage for girls and of
first pregnancy
4. Importance of weight monitoring and anaemia monitoring during pregnancy
and also among adolescent girls. Encouraging consumption of IFA during
pregnancy and lactation
5. Importance of institutional deliveries
6. Importance and benefits of consuming the Energy Dense Food (EDF) supplied
under the Project
All interventions of the project have now been initiated and are in operation. Early
results emerging from the projects from December 2015, (baseline) to July 2016 are
very encouraging. (Annexure -B- http://www.karnutmission.org/present-
projects.html )
It may be safely concluded that these nutritional improvements can be
related only to behavioural change resulting from the household messaging and
communication strategy developed by the Mission for the Pilot Projects.
It is expected that nutritional improvements will accelerate even faster during the next
few months, after consumption of EDF by the beneficiaries has started in October 2016
in Chincholi, and December 2016 in Devadurga.
EDF Composition for target groups
Table-2
Ingredients Age Group Portion
( grams per day)
Whole wheat (50g) Ragi ( 15g) Green gram dal (15g) Defatted soya (10g) Sugar (10g) Vitamin Mineral Premix
6-12 months 50
1-3 years 75
Whole wheat (45g) Ragi ( 15g) Green gram dal (15g) Defatted soya (10g) Groundnut(10g) Sugar (10g) Vitamin Mineral Premix
Adolescent girls 100
Pregnant women 110
Lactating Mothers 110
For more information, please visit our website: http://karnutmission.org
33
Annexure-A
The Inter-generational Cycle of Malnutrition and the Cycle of Calorie
Protein and Micro-nutrient Deficit (CPMD) and Poverty
The Two Concentric Cycles: Inter-generational Cycle of Malnutrition & Cycle of Calorie Protein Micronutrient Deficit (CPMD)
and Poverty
ANC: Antenatal Care
EBF: Exclusive Breast Feeding
Protein calorie micronutrient deficit
Low working capacity
Low income generation
Poverty
Low BirthWeight
Stunted Child
MalnourishedGirl
MalnourishedMother
Inadequate growth Low weight gain Poor DietGender discrimination Early marriage & pregnancy
• Poverty• Lack of awareness• Infections• Gender discrimination• Inadequate food &
health care
No feeding of colostrum Lack of EBF* for first 6 monthsDelayed & inadequate com food Frequent Infections & prolonged
diarrhea Gender discrimination Inadequate food &
health care
• Inadequate foetalnutrition
• Multiple pregnancies • -Gender discrimination
• Poor diet and ANC ** • Female illiteracy
34
Background Paper – Session 2
Creation of a 30 hour Module on Food/Nutrition Security and Public Policy for
inclusion in the Post-graduate Programme for Public Policy.
In spite of the alarming nutritional and micronutrient deficit and food deficit status of
our population, the subject has not yet entered the domain of the public policy debate,
whether at the academic or policy making levels. The only time the subject is
highlighted is when a new national or international report is released or when
unfortunate malnutrition deaths are reported in the country.
There are several reasons for this: such as, the invisibility of under nutrition; the fact that
the afflicted are not aware of their condition; the complexity and inter-sectoral nature of
chronic food and nutritional insecurity which even policy makers have not yet grasped.
All of these have resulted in an absence of public demand, and consequently lack of
pressure on policy makers for giving prioritizing the subject on the development agenda.
Policy makers or economists have also not taken cognizance of the enormous economic
loss caused to individuals and to the nation in terms of GDP, through under nutrition and
micronutrient deficiency of its work force.
Even in academia, or among professionals in the social development sectors, whether in
the governmental, non-governmental or governmental policy making sectors, there is
little composite subject matter, data or research regarding the complex causal
interconnectivity of causes of under nutrition and micronutrient deficiency, its social and
historical context, its behavioural and gender aspects. Even where there is information
and knowledge about this, there is absence of strategy or innovation to find a solution, as
the issue has still not become part of the Public Policy debate.
A case in point: A national programme to combat malnutrition within 6 months was
announced in the Budget speech of July 2014. Despite the fact that this has still not yet
happened, the subject has not become a public policy issue, and there is no lobby
agitating on this issue, even though the nutritional status of India`s population is among
the worst in the world.
Presently, this subject is not taught in any of the Public Policy courses, and this may
well be another reason as to why there is lack of information/ knowledge/ capacity
regarding this it both at the policy pushing and policy making side, or among
development consultants, think tanks or development professionals etc.
A 30 hour Module has been created as per the topics detailed below.
35
Expected Outcomes
The Module will fill up a great gap in our public policy debate, provide knowledge and
awareness to future professionals about our last unaddressed outpost of development,
and trigger off greater energy for influencing policy. Students doing the Masters in
Public Policy programme generally get employed as Consultants with Government, or
think tanks who work with government, such as Price Waterhouse and Tata Consultancy
Services, or with NGOs. Equipping them with knowledge regarding under nutrition and
public policy would enable them to become catalysts and agents of change, to
mainstream the subject of under nutrition and micronutrient deficiency in whatever
domain of public policy they are working with.
This initiative will be a strong advocacy tool for creating awareness and knowledge
among young professionals entering public policy related fields, regarding the hidden
scourge of malnutrition that is preventing our human resources from realizing their true
potential, preventing faster release from poverty, reducing India’s GDP.
To begin with Universities in Karnataka and elsewhere will be requested to incorporate
the Module in their Public Policy/Nutritional Sciences/Social Sciences curriculum.
Course Title
Masters in Public Policy (MPP),
Programme Title
Module on Food/Nutrition Security and Public Policy
Aims/Objectives
The course is designed to enable a student to:
Study India’s nutritional indicators and their causes.
Understand varied dimensions of Food and Nutrition Insecurity as it exists in India, and
how it impacts human resource development and economic development.
Critically examine the Policy responses, initiatives or lack of them, and their
effectiveness in addressing the problem of Food and Nutrition Security in India
Study the design and content of on-going national programmes addressing under
nutrition and micronutrient deficiency, and their impact
36
The module includes the following topics:
1. Food Security, Nutritional Security and Public Policy – India’s status today
2. Historical situation analysis of food and nutrition security in India. Causes for
Under nutrition and Micro-nutrient deficiency in India
3. Public Health implications of under nutrition and micronutrient deficiency on
individuals, communities and society
4. Economic implications of under nutrition and micronutrient deficiency on
individuals, communities and society
5. Gender, Caste and Ethnicity dimensions of under nutrition and micronutrient
deficiency
6. State and Policy Responses, Strategies in the 5 Year Plans: Present Policy
framework
7. Programmes and Interventions, Outcomes of existing programmes. Have they
worked?
8. International comparisons. What worked for reducing malnutrition in other
developing countries?
9. Field Visit Observations
10. Closing Seminar - What needs to be done to influence Policy
Field Visit:
In order to expose students to the actual face of malnutrition in the family and
community and existing efforts to address them, field visits will be organised to various
settings, not exceeding total module hours of 6. These visits will be facilitated to
institutions/points of delivery for nutrition related schemes, facilities to address
malnutrition (NRCs).
37
Background Paper – Session 3
Introducing Low Cost EDF in the market –Motivating the Private Sector
It has been agreed that one of the major causes of under nutrition and calorie-protein-
micronutrient deficiency among large sections of our population, especially the poorest
30-40 percent, is that there is presently a complete vacuum in the market for low cost,
fortified energy foods for BPL families.
The daily diets of the poorest families are meagre, and can at best qualify as subsistence
diets. For lack of money and knowledge, the families are not able to provide nutrition
required for healthy growth of children and adolescents during rapid growth periods, for
women during pregnancy and lactation, for all age groups of both genders during or after
illness, and complementary food for infants after 6 months of age.
At the macro level, even though the per capita income has more than quadrupled in the
last decade, all NNMB Reports, the last being NNMB Technical Report No. 26, 2012,1
continuously show a large dietary deficit in terms of protein, calorie and micronutrients
among more than 50% of our population of both sexes and all age groups, despite the
ICDS and MDM having been in operation for the last four and two decades respectively.
Nearly 50 per cent of adolescent girls aged 15–19 in India are underweight, with a body
mass index of less than 18.5, as per the UNICEF Report 2011
What is most worrisome is that early data emerging from the NFHS- 4 Factsheets (2015-
16) covering 17 States, informs us that the percentage of children from 6-23 months
receiving an adequate diet ranges from a meagre 5.9% to 31.1%. This is a serious issue
which is the source of under-nutrition in the life cycle of our population.
1Report of the Third Survey: “Diet and Nutritional Status of Rural Population. Prevalence of Hypertension and
Diabetes among Adults and Infants and Young Child Feeding Practices” (2011-12)
http://nnmbindia.org/1_NNMB_Third_Repeat_Rural_Survey___Technicl_Report_26.pdf 3rd Repeat Survey,
2011-12
38
Reports from the field in the Chincholi and Devadurga Projects clearly indicate that all
cases of severely malnourished children are from households where both parents are
engaged in construction or agricultural labour. The infants are left under the care of elder
siblings or grandparents, and apart from some roti, rice and dal, which an infant certainly
cannot eat; there is no food in the house. And in the market, there is nothing for them,
except wafers and biscuits.
I am also informed that there is a move in the Ministry of Women and Child
Development, Govt. of India, to introduce the system of cash transfers in lieu of
supplementary food under the ICDS. In such a situation where cash transfers are
made for purchase of energy dense food for infants, adolescents and pregnant and
nursing women, and there is no appropriate product in the market, what will the
families buy?
Our nutrition governance needs to engage with the food processing private sector as
custodian of the food industry and the pharmaceutical sector. They are already providing
several varieties of expensive protein and energy dense foods for children and adults of
the more affluent classes. However, for BPL populations of all age groups and both
genders, there is presently a huge market vacuum for low-cost energy foods.
Unfortunately, this vacuum has been filled up by junk foods and tobacco based products
39
that are marketed aggressively. Evidence from rural areas also reveals that the poor are
forced to purchase expensive energy foods, the only ones available in the market, when
they are faced with a serious health emergency or when acute malnutrition becomes life
threatening, sometimes spending their entire week’s wages for purchasing these
products.
The private sector must be requested to partner in our efforts for making available
appropriate low-cost energy foods for poor, undernourished and anaemic children,
women, adolescent girls and boys, the sick, aged and infirm, in rural and urban markets.
The numbers are large enough to support a viable business proposition. The recent
amendment to Schedule VII of the Companies Act 2013 includes, ‘eradicating hunger,
poverty and malnutrition, promoting preventive health care and sanitation and making
available safe drinking water’ as areas of Corporate Social Responsibility. This makes it
incumbent upon government and stakeholders to sensitize the private sector towards the
nutritional needs of the poor, and secure their partnership in the most productive way.
The target population is numerically large enough for the enterprise to be
commercially viable.
Use of effective rural marketing strategies for the new products can be done. Several
corporates in India have succeeded in penetrating rural markets with their products, such
as toiletries and cosmetics, (that were never earlier used by the poor), junk food items,
such as wafers and chips, that are now being used as food substitutes for children,
worsening their nutritional status.
An amount of about Rs 30 lakhs in the WB/JSDF Budget has been allocated for
Innovative Projects and Research. We might also have some additional unspent money,
which we could also use for Innovative Projects.
This proposal has been agreed to by the World Bank in principle. We could start by
conducting a Needs Assessment and Feasibility Study by engaging the services of a
food and agriculture business consulting group, to build a road map for motivating
and perhaps partnering with the private sector to set up a viable unit for
production of low cost high energy dense food for children, adolescents, women
40
during pregnancy and lactation, for all age groups of both genders during or after illness,
and complementary food for infants after 6 months of age.
Summing up:
Presently, there is a vacuum in the Indian market for low cost energy foods for all
age groups and both genders of the BOP populations, which has been filled up by
junk foods and tobacco based products that are marketed aggressively. This market
vacuum is to a large extent responsible for persisting under nutrition and micronutrient
deficiency among children, women and adolescents among the poorest sections of the
population.
Evidence reveals that the poor are forced to purchase expensive foods, the only
ones available in the market, when they are faced with a serious health emergency or
acute malnutrition that is life threatening. It is also reported that they spend their entire
week’s wages for purchasing these products.
At least 10-15% of the population is above the poverty line, but still suffers from
under nutrition and micronutrient deficiency. (100-150 million people) Hence, they
have purchasing power, but there are no products available to them to improve their
nutritional status. Hence, there is already a large market available, but there is no
product in the market.
Plenty of FSSAI approved compositions are presently available using local farm
produce, such as millet, wheat, soya, ground nut, jaggery, pulses.
This initiative is in accordance with the National Nutrition Policy recommendation-
‘Popularisation of Low Cost Nutritious Food: Efforts to produce and popularise low-
cost nutritious foods from indigenous and locally available raw material shall be
intensified. It is necessary to involve women particularly in this activity.’
This subject will be discussed in Session 3 of the Workshop.